Journal
NEUROLOGY
Volume 82, Issue 3, Pages 230-238Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0000000000000032
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Funding
- Institute for Formation and Research of the Foundation Marques de Valdecilla, Instituto de Salud Carlos III [PI12/02288]
- European Union Joint Programme-Neurodegenerative Disease Research [DEMTEST PI11/03028]
- United States NIH [K23-AG031861, R01-AG027859, R01-AG032306, R01-AG038791, P50-AG16570, P01-AG12435, P01-AG1972403, P50-AG023501]
- State of California Department of Health Services Alzheimer's Disease Research Center of California [04-33516]
- Alzheimer's Association [NIRG-07-59422]
- John Douglas French Alzheimer's Foundation
- Hellman Family Foundation
- Tau Consortium
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Objective:To evaluate the effect of amyloid imaging on clinical decision making.Methods:We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary -amyloid (A) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from A to non-A diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using (2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%).Results:Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-A diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis.Conclusions:PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.
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